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TABLE 8–4. Age Correction Case Study Results — Right Ear
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AUDIOMETRIC TEST FREQUENCY (Hz)
500 1000 2000 3000 4000 6000
Baseline
5 5 10 10 15 5
(Age = 25 Years)
Current
5 10 20 20 35 25
(Age = 40 Years)
Average Change in Thresholds
(2000, 3000, and 4000 Hz)
Baseline Average = 11.67
Current Average = 25
Average Change in Thresholds = 13.33
Age Correction Values at 25 Years 3 5 7
Age Correction Values at 40 Years 6 10 14
Difference in Age Correction Values 3 5 7
Age-Corrected Current Thresholds 17 15 28
Age-Corrected Average Change in
Thresholds (2000, 3000, and 4000 Hz)
Baseline Average = 11.67
Age-Corrected Current Average = 20
Age-Corrected Average Change in
Thresholds = 8.33
STS
No Age-
Corrected
STS
TABLE 8–5. Age Correction Case Study Results — Left Ear
AUDIOMETRIC TEST FREQUENCY (Hz)
500 1000 2000 3000 4000 6000
Baseline
5 5 10 15 15 10
(Age = 25 Years)
Current
10 10 10 25 40 20
(Age = 40 Years)
Average Change in Thresholds
(2000, 3000, and 4000 Hz)
Baseline Average = 13.33
Current Average = 25
Average Change in Thresholds = 11.67
Age Correction Values at 25 Years 3 5 7
Age Correction Values at 40 Years 6 10 14
Difference in Age Correction Values 3 5 7
Age-Corrected Current Thresholds 7 20 33
Age-Corrected Average Change in
Thresholds (2000, 3000, and 4000 Hz)
Baseline Average = 13.33
Age-Corrected Current Average = 20
Age-Corrected Average Change in
Thresholds = 6.67
STS
No Age-
Corrected
STS
402
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factors in determining whether an STS has occurred. To apply age correction factors, the following
steps are used:
n
Use Tables F–1 (for males) and F–2 (for females) from the OSHA (1983) noise standard
to find the age correction values for each frequency for the employee’s age at the baseline
(25years) and the current evaluation (40 years). These values are shown in the fourth and
fifth lines of Table 8–4 (right ear) and Table 8–5 (left ear).
n
At each frequency, calculate the difference between the age correction factors for the
employee’s current age compared to his age at the baseline (i.e., subtract the baseline values
from the current age values). These difference values represent the amount of hearing loss that
may be attributed to aging between the baseline and the current audiogram.
n
For each frequency, the difference value is subtracted from the threshold obtained at the
current annual audiometric evaluation. Table 8–4 (right ear) and Table 8–5 (left ear) show the
baseline thresholds and the age-corrected thresholds for the current audiogram in each ear.
Using the age-corrected current thresholds, the employee’s change in hearing no longer meets the
criteria for an STS in either ear.
n
Right ear
Baseline average of 2000, 3000, and 4000 Hz = 11.67 dB
Current average of 2000, 3000, and 4000 Hz using age corrections = 20 dB
Shift = 8.33 dB
n
Left ear
Baseline average of 2000, 3000, and 4000 Hz = 13.33 dB
Current average of 2000, 3000, and 4000 Hz using age corrections = 20 dB
Shift = 6.67 dB
OSHA (2001) requires that a hearing loss be recorded in the OSHA 300 Log of Work-Related
Injuries and Illnesses when an STS is present (age corrections are allowed); the current audiogram
shows hearing thresholds of an average of 25 dB HL or greater at 2000, 3000, and 4000 Hz; and
the shift in hearing is related to occupational noise exposure (Wells, 2014). If age correction factors
are not applied, this employee’s hearing loss would be recorded in the OSHA Log, and his current
annual audiogram would become his new baseline audiogram. If age correction factors are applied,
the employee’s hearing loss would not be recorded in the OSHA Log; therefore, his hearing test results
obtained at 25 years of age would continue to be used as his baseline audiogram.
Referral Criteria
The American Academy of Otolaryngology-Head and Neck Surgery (1997) has published the Otological Referral Criteria for Occupational Hearing Conservation Programs. Although not required by OSHA
or NIOSH, the criteria are helpful in determining when changes in hearing or abnormal conditions
likely require medical evaluation. Medical referral should be made if:
n
The baseline audiogram shows an average hearing threshold of 25 dB HL at 500, 1000, 2000,
and 3000 Hz in either ear or if the difference in the average hearing threshold between ears is
more than 15 dB at 500, 1000, and 2000 Hz or more than 30 dB at 3000, 4000, and 6000Hz.
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n
The annual audiogram shows a decline in the average hearing threshold in either ear of 15 dB
at 500, 1000, and 2000 Hz or more than 20 dB at 3000, 4000, and 6000 Hz compared to the
baseline audiogram.
n
There is a history of ear signs or symptoms, such as ear pain, drainage, dizziness, severe
and persistent tinnitus, sudden fluctuating or rapidly progressing hearing loss, or fullness/
discomfort in either ear in the last year.
n
There is cerumen obstructing the ear canal.
Hearing Conservation Education and Training
Numerous studies have shown that the majority of children (e.g., Reel et al., 2022) and adults (e.g.,
Carroll et al., 2017) seldom or never wear hearing protection around loud noise. Hearing conservation
programs for children and adults aim to educate and motivate participants to protect their hearing.
The OSHA (1983) noise regulation requires that occupational hearing conservation programs include
five key components:
1. Effects of noise on hearing
2. Purpose of hearing protectors
3. Advantages, disadvantages, and attenuation of different types of hearing protectors
4. Instructions on selection, fitting, use, and care of hearing protectors
5. Purpose of audiometric testing and explanation of the test procedures
Other hearing conservation programs for children and adults address similar topics, with the common
goal being to prevent NIHL.
Recommended Readings
Hutchison, T. L., & Schulz, T. Y. (Eds.). (2014).
Hearing conservation manual (5th ed.). Council
for the Accreditation in Occupational Hearing
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Meinke, D. K., Berger E. H., Neitzel R. L., Driscoll,
D. P., & Bright, K. (Eds.). (2022). The noise manual
(6th ed.). American Industrial Hygiene Association.
Occupational Safety and Health Administration. (1983).
Occupational noise exposure: Hearing conservation
amendment; Final rule (Standard No. 29CFR
1910.95). Federal Register, 48(46), 97429772.
Rawool, V. W. (2012). Hearing conservation in occupa-
tional, recreational, educational, and home settings.
Thieme Publishing.
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Practice Questions
1. An audiologist is performing annual audiometric testing for a company that manufactures
oil field pipelines. According to requirements of the Occupational Safety and Health
Administration (OSHA), which of the following criteria must be used to determine if each
employee has had a standard threshold shift compared to their baseline audiogram?
a. Hearing thresholds have changed by an average of 15 dB or more at 1000, 2000, and
4000Hz in either ear.
b. Hearing thresholds have changed by 10 dB or more in either ear at any of the following
frequencies: 1000, 2000, or 4000 Hz.
c. Hearing thresholds have changed by 15 dB or more in either ear at any of the following
frequencies: 500, 1000, 2000, or 4000 Hz.
d. Hearing thresholds have changed by an average of 10 dB or more at 2000, 3000, and
4000Hz in either ear.
Explanation: OSHA (1983) defines a standard threshold shift (STS) as an average change of 10 dB or
more at 2000, 3000, and 4000 Hz in either ear compared to the baseline audiogram. NIOSH (1998)
defines a standard threshold shift as a change of 15 dB or more in either ear at any of the following
frequencies: 500, 1000, 2000, 3000, 4000, or 6000 Hz. Therefore, d is the correct answer.
2. An adult who works in very high-intensity noise wears “double” hearing protection: foam
earplugs with a noise reduction rating (NRR) of 32 dB and protective earmuffs with a noise
reduction rating of 25 dB. According to OSHA regulations, wearing the earplugs and earmuffs
simultaneously should provide approximately how much noise reduction (attenuation)?
a. 30 dB
b. 37 dB
c. 47 dB
d. 57 dB
Explanation: According to OSHA (1983), employers can require double hearing protection if there
is evidence of progressive NIHL. Wearing the second hearing protection device is assumed to provide
an increase of 5 dB over the attenuation of the HPD with the higher NRR. In the example, the higher
NRR is 32, so adding a second HPD would provide approximately 37 dB of attenuation. Therefore,
b is the correct answer.
3. A 50-year-old adult wears earmuffs over his baseball cap and safety glasses at work. Which of the
following types of individual fit testing would be most appropriate for the audiologist to use to
measure the amount of noise reduction (attenuation) the worker actually receives when wearing
his hearing protection at work?
a. Real ear attenuation at threshold
b. Loudness balance
c. Field microphone in-the-ear
d. OSHA correction factor
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Explanation: Real ear attenuation at threshold (REAT) is the gold standard for fit testing. It can be
performed in a sound booth and involves measuring the patient’s thresholds with and without hearing
protection. This will allow the patient to wear his own earmuffs over his baseball cap and safety glasses
as he normally would at work. F-MIRE systems typically come with special earplugs with the probe
built in, which means the patient could not be tested while wearing his own earmuffs. Loudness
balance systems require the patient to wear headphones over earplugs. The OSHA correction factor is
only applied to the NRR reported for a particular type of hearing protection. It allows for estimation
of the attenuation provided by different types of hearing protection and does not involve actually
measuring the attenuation. Therefore, a is the correct answer.
4. A 41-year-old male works in a tire factory. His job involves working in two different areas of
the factory, one inside and one outside. Noise measurement results reveal 97 dB LAeq at his
indoor work location and 88 dB LAeq at his outdoor location. On average, he spends 6 hours
at the indoor location and 2 hours at the outdoor location each day. Which of the following is
closest to the worker’s daily noise dose using recommendations from the National Institute for
Occupational Safety and Health (NIOSH)?
a. 200%
b. 1,250%
c. 1,600%
d. 1,800%
Explanation: According to NIOSH (1998), a person can be exposed to 97 dBA safely for 0.5 hours
and 88 dBA for 4 hours. Using these values and the equation for dose shown below, the worker’s daily
dose would be approximately 1,250%. Therefore, b is the correct answer.
D = [C1/T1 + C2/T2 + Cn/Tn] × 100
D = [6/0.5 + 2/4] × 100
D = [12 + 0.5] × 100
D = 1250%
Where:
Cn = total time of exposure at a specified noise level
Tn = exposure time at which noise for this level becomes hazardous
5. In order to comply with the Occupational Safety and Health Administration’s (OSHA) noise
regulation, which of the following workers would not be required to wear hearing protection
devices?
a. A worker who is exposed to an 8-hour time-weighted average (TWA) of 92 dBA
b. A worker who is exposed to an 8-hour time-weighted average (TWA) of 85 dBA who has not
experienced a standard threshold shift (STS)
c. A worker who is exposed to an 8-hour time-weighted average (TWA) of 88 dBA and has
experienced a standard threshold shift (STS)
d. A worker who started working at the company 8 months ago and is exposed to an 8- hour
time-weighted average (TWA) of 89 dBA but has not received their baseline audiogram yet
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Explanation: According to the OSHA (1983) noise regulation, hearing protection must be worn by
employees when:
n
Exposure is 90 dBA TWA or greater
n
Exposure is 85 dBA TWA or greater if:
No baseline audiogram has been obtained after 6 months of exposure at or above
85 dBA TWA
An STS has occurred
Therefore, b is the correct answer.
6. A child with noise-induced hearing loss is most likely to show a noise notch at which of the
following frequencies?
a. 2000 Hz
3000 Hz
b.
c. 4000 Hz
d. 6000 Hz
Explanation: Research shows that for children with noise-induced hearing loss, the noise notch typically occurs at 6000 Hz (Niskar et al., 2001). Therefore, d is the correct answer.
7. A 56-year-old male works around heavy machinery in a factory, but he does not consistently
wear hearing protection because he feels that he cannot hear speech when he wears them. Which
of the following types of hearing protection would be most appropriate to protect the worker’s
hearing while still addressing his concerns regarding hearing speech?
a. Custom earplugs (no filters)
b. Semi-insert earplugs with a band that goes behind his head
c. Flat attenuation (high-fidelity) earplugs (custom or noncustom)
d. Traditional earmuffs
Explanation: Traditional earplugs and earmuffs typically attenuate high frequencies more than mid
and low frequencies. Flat attenuation earplugs and earmuffs (also called uniform attenuation, high
fidelity, or musicians plugs) are designed to provide approximately even attenuation across the frequency range, thus preserving the natural balance between the low-frequency fundamental energy and
the high-frequency harmonic energy. This can be beneficial for music listening and speech understanding. Therefore, c is the correct answer.
8. An audiology practice has contracts with several large companies to conduct their employees’
annual audiological evaluations. In order to comply with OSHA regulations, which of the
following lists all the frequencies that are required to be tested?
a. 250, 500, 1000, 2000, 3000, and 4000 Hz
b. 500, 1000, 2000, 3000, 4000, and 6000 Hz
c. 250, 500, 1000, 2000, 4000, and 8000 Hz
d. 500, 1000, 2000, 3000, 4000, and 8000 Hz
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